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Benzodiazepines and Other Sedative-Hypnotics in the Older Adult 

Benzodiazepines and Other Sedative-Hypnotics in the Older Adult
Chapter:
Benzodiazepines and Other Sedative-Hypnotics in the Older Adult
Author(s):

Arthur Robin Williams

and Olivera J. Bogunovic

DOI:
10.1093/med/9780199392063.003.0007
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date: 21 November 2019

Sedative-hypnotic-use disorder is a serious problem in the elderly and is a growing concern in the United States. The American Geriatrics Society’s “Choosing Wisely” initiative cautions against the use of any benzodiazepines or other sedative-hypnotics as initial treatment in older adults, yet benzodiazepines are the most frequently prescribed drugs in the elderly for both insomnia and anxiety. Other classes of medication (e.g., serotoninergic antidepressants) may be substituted for benzodiazepines based on diagnosis. With advancing age, the elderly are more sensitive to the potential side effects of benzodiazepines because of altered pharmacokinetics and pharmacodynamics Increasingly, studies have indicated that older patients disproportionately experience adverse events with benzodiazepines such as falls and cognitive deficits and have difficulty reducing or stopping long-term use without experiencing rebound effects such as anxiety and insomnia. Sedative-hypnotic-use disorders among older adults are increasing in prevalence and warrant heightened clinical attention, thoughtful assessment, and active management.

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